Director, Forensics Healthcare

Job Summary:

BDO is seeking a seasoned healthcare expert testifier to join its rapidly growing Healthcare Forensics practice. This individual will play a critical leadership role in high-stakes healthcare litigation, arbitration, and payer/provider disputes, with a particular focus on hospital/inpatient reimbursement, DRG coding, and payment integrity. The ideal candidate brings a proven track record of expert testimony, deep subject matter expertise in Medicare Severity Diagnosis-Related Groups (MS-DRGs) and inpatient billing practices, and the ability to lead complex engagements while developing junior staff in a highly leveraged consulting model. This role is central to supporting BDO’s continued expansion in large-scale disputes where clinical, coding, and financial issues intersect.

Job Duties:

• Serves as a testifying expert in healthcare litigation matters, including depositions, trial testimony, arbitration proceedings, and other dispute forums
• Develops and defends expert opinions related to DRG assignment and validation, medical necessity and inpatient admission criteria, coding accuracy, CMS and payer-specific guidelines, bundling, downcoding, reimbursement methodologies, and payment integrity
• Leads end-to-end engagement delivery for healthcare litigation, arbitration, payer/provider disputes, forensic, reimbursement, payment integrity, compliance, and operational consulting engagements
• Develops engagement scope, analytical approach, methodologies, data requirements, analysis design, quality control processes, and report preparation workplans
• Provides subject matter leadership on MS-DRG classification systems, grouper logic, ICD-10-CM/PCS coding frameworks, Medicare IPPS rules, CMS regulatory guidance, and commercial payer reimbursement policies impacting inpatient claims
• Oversees large-scale data-driven analyses of hospital claims, payment patterns, coding outcomes, DRG validation findings, inpatient billing practices, medical necessity issues, and reimbursement impact
• Evaluates and develops methodologies to assess theories of harm in payer/provider disputes and translates coding, clinical, and reimbursement issues into quantifiable, defensible analyses
• Authors and supports clear, defensible expert reports, expert analyses, presentations, and client deliverables, and prepares to withstand cross-examination or other legal challenges
• Works closely with counsel, health systems, payers, healthcare executives, analytics teams, and internal stakeholders in privilege-aware, deadline-driven litigation environments
• Simplifies complex coding, reimbursement, medical necessity, data, and regulatory concepts for legal counsel, executives, triers of fact, and other non-technical audiences
• Manages multiple concurrent engagements with tight and overlapping deadlines, including staffing, workflow discipline, quality control, risk management, and margin/realization awareness
• Collaborates with leadership on business development efforts, including proposal development, client presentations, expert positioning, expansion of existing relationships, identification of new service offerings, and market opportunities
• Builds and maintains relationships with law firms, health systems, payers, and other healthcare clients, and supports BDO’s positioning as a trusted advisor in healthcare disputes, forensic analysis, and expert testimony
• Monitors and implements industry trends, legal and regulatory developments, coding and reimbursement guidance, and best practices; creates a positive, collaborative, accountable, and team-focused environment
• Other duties as required

Supervisory Responsibilities:

• Supervises projects, often multiple concurrent projects, in healthcare litigation, arbitration, forensic, reimbursement, DRG validation, payment integrity, compliance, and operational consulting engagements
• Operates within BDO’s leveraged delivery model by effectively assigning, delegating to, managing, coaching, and developing Managers, Senior Associates, and Associates
• Provides technical oversight and quality control across engagement teams, including review of coding analyses, reimbursement methodologies, data-driven findings, expert report support, and client deliverables
• Mentors and trains junior staff on coding and reimbursement fundamentals, DRG/inpatient concepts, analytical methodologies, litigation support best practices, report support, documentation, and defensible work product development